Contributed by Jennifer Chapman, M.D.
Differential diagnostic algorithm
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Nodules
Contributed by Jennifer Chapman, M.D.
ATLL mimicking angioimmunoblastic T cell lymphoma
ATLL with Hodgkin-like cells mimicking classical Hodgkin lymphoma
ATLL mimicking mycosis fungoides
ATLL, lymphomatous type, mimicking anaplastic large cell lymphoma
Contributed by Jennifer Chapman, M.D.
ATLL, acute variant,
mimicking
T prolymphocytic
lymphoma
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Flower cells
CLL-like morphology
Contributed by Jennifer Chapman, M.D.
CD45
CD4
CD56
CD7
CD25
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CD3+, CD4+, CD25+, CD7-, CD8-
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ATLL cell
Contributed by Siba El Hussein, M.D. and Joseph Khoury, M.D.
Neoplastic cells involving the bone marrow
Neoplastic cells involving the bone marrow
Immunohistochemical stains
Contributed by Siba El Hussein, M.D. and Joseph Khoury, M.D.
Flow cytometry characteristic
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Hb Bart’s, midpregnancy sonographic features
Contributed by Patricia Tsang, M.D.
Case of the Month #486
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HGA: inclusions in granulocytes
Left: HGA (HGE)
Contributed by Erika Wheeler, M.D. and Bobbi Pritt, M.D.
Intracellular and extracellular Babesia ring forms
Multiple Babesia ring forms
Giemsa stained thick and thin blood films
Giemsa stained thick and thin blood films
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Tetrad form
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CT scan
Contributed by Béla Kajtár, M.D., Ph.D.
Paraaortic lymph nodes
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Splenic involvement
Contributed by Béla Kajtár, M.D., Ph.D.
Proliferation centers
Diffuse lymphocytic infiltrate
Proliferation center
CD20
LEF1
Bone marrow involvement
Contributed by Béla Kajtár, M.D., Ph.D.
Touch prep SLL
Contributed by Béla Kajtár, M.D., Ph.D.
CLL in peripheral blood
Contributed by Béla Kajtár, M.D., Ph.D.
CLL, scatter plot
Contributed by Béla Kajtár, M.D., Ph.D.
FISH images
Karyogram
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Skin lesions
Gingivitis, periodontitis
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Clinical and histological profile
IL-17 signature
Skin biopsy
Contributed by Dr. Mark R. Wick
Childhood disease, AFB stain
Childhood disease
Childhood disease, PAS stain
Contributed by David Lynch, M.D.
Bone marrow core and CD68
Bone marrow aspirate
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Megaloblastic erythroid precursors
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Hypersegmented neutrophils, macro ovalocytes
Contributed by Pallavi Khattar, M.D. and Case #437
Bone marrow biopsy
CD20 immunostain
Bone marrow aspirate
Bone marrow aspirate
Bone marrow biopsy
Bone marrow aspirate
Bone marrow aspirate
CD20 immunostain
CD3 immunostain
DBA-44 immunostain
Contributed by Daniel D. Mais, M.D.
Peripheral blood smear (Wright stain)
Hemoglobin electrophoresis
Contributed by Roberto N. Miranda, M.D.
Bone marrow infiltration
Bone marrow with dyspoietic changes
CD3 positive
CD4 negative
CD8 negative
TCR βF1 negative
TCRγδ positive
Liver infiltration
HSTCL: CD3 positive
HSTCL: CD4 negative
CD8 positive
TIA1 positive
Small size morphology
Intermediate size morphology
Blastic morphology
Contributed by Roberto N. Miranda, M.D.
Positivity for CD2, TCRγδ and CD56
Contributed by Fnu Raja, M.B.B.S.
Microcytic and hypochromic RBCs
Iron deficiency anemia
Contributed by Nicholas Nowacki, M.D.
Lymphoid infiltrate
Small lymphoma cells
Marrow aspirate
CD3 highlights T cells
CD5 positive
CD20 positive
Cyclin D1 positive
SOX11 negative
Contributed by Nicholas Nowacki, M.D.
Peripheral blood
Contributed by Nicholas Nowacki, M.D.
Aberrant CD5 coexpression
CD20 moderate expression
Surface light chain restriction
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Characteristic immunophenotype
Immunophenotypic comparison
Table 1: B cell lymphoproliferative disorders and markers
| CD45RA | CD19 | CD20 | CD79a | CD5 | CD10 | CD23 | Cyclin D1 | SOX11 | LEF1 | CD200 | CD103 | CD11c | CD25 | |
| Follicular lymphoma | + | + | + | + | - | + | - | - | -/+ | Unknown | - | - | -/+ | -/+ |
| Chronic lymphocytic leukemia / small lymphocytic lymphoma | + | + | + | + | + | - | + | - | - | +/- | + | - | -/+ | -/+ |
| Diffuse large B cell lymphoma | + | + | + | + | - | +/- | - | - | -/+ | -/+ | +/- | -/+ | -/+ | -/+ |
| Mantle cell lymphoma | + | + | + | + | + | - | - | + | + | - | - | - | - | -/+ |
| Marginal zone lymphoma | + | + | + | + | - | - | - | - | -/+ | - | - | - | -/+ | - |
| Lymphoplasmacytic lymphoma | + | + | + | + | - | - | - | - | Unknown | - | +/- | - | +/- | +/- |
| Hairy cell leukemia | + | + | + | + | - | - | - | + | +/- | - | + | +/- | + | + |
| +: positive; -: negative; +/-: majority positive; -/+: majority negative | ||||||||||||||
Table 2: T cell lymphoproliferative disorders and markers
| CD4 / CD8 | Pan-T cell markers (CD2, CD3, CD5, CD7) | CD30 | T cell receptor | |
| T cell prolymphocytic leukemia | CD4+ / CD8- > CD4+ / CD8+ | All expressed | - | Alpha / beta |
| Sézary syndrome | CD4 | CD7 loss | +/- | Alpha / beta |
| Adult T cell leukemia / lymphoma | CD4 | CD7 loss | -/+ | Alpha / beta |
| T cell large granular lymphocytic / leukemia | CD8 | CD2, CD5 and CD7 variably loss | - | Alpha / beta |
| +: positive; -: negative; +/-: majority positive; -/+: majority negative | ||||
Contributed by Jingwei Li, M.D., Ph.D., Olga Pozdnyakova, M.D., Ph.D. and Karry Charest, MT (ASCP)
Clumped chromatin, smudge cells
Moderately clumped chromatin
Cleaved nuclei
Fine, hair-like cytoplasmic projections
Round to irregular nuclei
Irregular, cerebriform nuclear contour
Polylobed nuclei, flower cells
Eccentric, round nuclei
Large sized neoplastic cells
Abundant cytoplasm, azurophilic granules
Dispersed chromatin, distinct nucleoli
Irregular, convoluted nuclear contours
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Pre- and post-treatment
Alopecia and erythroderma
Contributed by Shamayel Mohammed, M.D.
Distinct cortex
Diffuse histiocytic infiltrate
Patient with SCID
Ziehl Neelsen+
EBV+
CD30+ immunoblasts
CD20+
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Parakeratosis and lymphohistocytic infiltrate
H&E, S100
CD30
Contributed by Shamayel Mohammed, M.D.
Ziehl-Neelsen+
Histiocytes
Contributed by Samantha Mack, M.D.
Donath-Landsteiner
assay interpretation
worksheet
Donath-Landsteiner tube assay example
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Suggested pathophysiology of PNH
Suggested pathophysiology of hemolysis in PNH
Complement action in healthy subjects and PNH patients
Contributed by Saja Asakrah, M.D.
High sensitivity PNH flow cytometry
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Fever paroxysm
Life cycle
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Adult of Anopheles freeborni
Contributed by Bobbi Pritt, M.D.
P. falciparum malaria, > 10% parasitemia, negative rapid antigen, Giemsa stained thin blood smear
Giemsa stained thick and thin peripheral blood films from a patient with malaria due to P. falciparum; > 20% parasitemia
Contributed by Patricia Tsang, M.D., M.B.A.
Plasmodium falciparum (blood smear)
Case #277
Blood smear
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Ring form trophozoites of P. falciparum
Maurer clefts
Older trophozoites of P. falciparum
Gametocytes of P. falciparum
Schizonts of P. falciparum
Contributed by Richard K. Wood, M.D. and Dietrich Werner, M.D.
Bone marrow involvement
CD20 positivity in bone marrow
CD79a positivity in bone marrow
Cyclin D1 negativity in bone marrow
Contributed by Allam Shawwa, M.D.
Prolymphocytes in peripheral blood
Prolymphocytes in peripheral blood
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Inclusions of nuclear chromatin remnants
Contributed by Linlin Wang, M.D., Ph.D. and Sonam Prakash, M.B.B.S.
Peripheral neutrophilia
Toxic granulation and Döhle bodies
Cytoplasmic vacuoles in neutrophil
Immature granulocytes and rare blast
Pseudo-Pelger-Huët neutrophils
Large neutrophils
Toxic granulation (red granules)
Contributed by Roberto N. Miranda, M.D.
Prominent exfoliative lesion
Prominent erythroderma
Contributed by Roberto N. Miranda, M.D.
Central nervous system (CNS) involvement
Contributed by Roberto N. Miranda, M.D.
Bone marrow involvement
CD3 positivity
Epidermotropic and lichenoid lymphoid infiltrate
Epidermotropic infiltrate
Cerebriform cytology
Lymph node involvement
Cytological atypia
Contributed by Roberto N. Miranda, M.D.
Lymph node touch print
Contributed by Roberto N. Miranda, M.D.
Cerebriform lymphocytes in peripheral blood smear
Contributed by Roberto N. Miranda, M.D.
Flow cytometry in SS
Contributed by Min Shi, M.D., Ph.D. and Dragan Jevremovic, M.D., Ph.D.
T LGLL bone marrow involvement
Intrasinusoidal CD3+ T LGLL
Intrasinusoidal CD8+ T LGLL
Intrasinusoidal granzyme B+ T LGLL
Intrasinusoidal TIA1+ T LGLL
T LGLL liver involvement
CD8+ T LGLL in liver
CD5- T LGLL in liver
TIA1+ T LGLL in liver
Contributed by Min Shi, M.D., Ph.D. and Dragan Jevremovic, M.D., Ph.D.
T LGLL in peripheral blood
Contributed by Min Shi, M.D., Ph.D. and Dragan Jevremovic, M.D., Ph.D.
T LGLL flow cytometry
Contributed by Min Shi, M.D., Ph.D. and Dragan Jevremovic, M.D., Ph.D.
Diffuse bone marrow involvement
Splenic red pulp infiltrate
Monotonous, paracortical lymphoid infiltrate
Intermediate size, atypical lymphocyte
CD3 positivity in bone marrow
Monotonous T cell infiltrate
TCL1A positivity
Uniform strong TCL1A staining
Contributed by Min Shi, M.D., Ph.D. and Dragan Jevremovic, M.D., Ph.D.
Cerebriform variant
Prolymphocytes in peripheral blood
Small cell variant
Contributed by Min Shi, M.D., Ph.D. and Dragan Jevremovic, M.D., Ph.D.
T PLL flow cytometry
Contributed by Min Shi, M.D., Ph.D. and Dragan Jevremovic, M.D., Ph.D.
FISH for TCL1A separation
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Hyperpigmentation before treatment
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Atrophic gastritis with intestinal metaplasia
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Hypersegmented neutrophil
Macrocytes, macro-ovalocytes,
nucleated RBCs and hypersegmented neutrophils
Glassy: 2018
Hoyer: 2003
Kaushansky: 2021
Keohane: 2015
Medeiros: 2017
Sallman: 2016
Turgeon: 2017
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